Breast Cancer: Dispelling the myths

Melita Charles, a surgical oncologist at Long Island College Hospital in Brooklyn, N.Y., dispels some of the myths about breast cancer and its treatment.

The Network Journal: What is the greatest misconception about breast cancer?Melita Charles, M.D.: That it’s the No. 1 killer of women. Heart disease is the primary killer of women. That doesn’t mean women shouldn’t be concerned about breast cancer. Among cancers, it’s still the leading cause of death of women in their fifth decade. But a key message for women is not to panic, not even if they hear the word “tumor.”

TNJ: Not panic at the word “tumor”?Dr. Charles: “Tumor” simply means an abnormal growth of tissue. It usually isn’t malignant. Two very common benign breast conditions are fibroadenomas—solid, but benign, tumors—and cysts, which are lumps filled with fluid.

TNJ: What advances have been made in diagnosing breast growths and lumps? Dr. Charles: The increased use of ultrasound has been very important, especially in younger women under 40, when breast tissue is very dense and mammogram, which is an x-ray, can’t see through it. When I see a 25-year-old with a breast lump, I first do an ultrasound to see if the lump is solid or cystic. Another exam that’s especially useful in high-risk young women is an MRI.

TNJ: Is that the major change in diagnosis?Dr. Charles: Two types of diagnostic biopsies have made major differences in making treatment more effective and minimizing pain and breast damage. A stereotactic biopsy is performed in the radiology suite in an hour or less. A woman lies face down on a table and the breast hangs down. A vacuum pulls her breast into a needle trough that removes tissue samples. There’s little or no pain and no scar for most women. Then there’s a sentinel node biopsy, which helps us determine if cancer has spread and, if so, how far. We used to remove many lymph nodes and have the pathologist examine them all. That was a very invasive procedure; it required a drain left in for one week and sometimes you needed physical therapy. Now we’ve found the lymph ducts spread to one node first, called the sentinel node. We find that node by injecting a dye and a radioactive tracer, then we remove and biopsy it. There’s usually no need for an overnight stay, or drains, or physical therapy.

TNJ: Tell us about the major changes in treating breast lumps.Dr. Charles: We used to automatically remove cysts if they kept coming back, but now we either leave them alone or, if they’re truly bothersome, we use a needle to drain the fluid. For fibroadenomas, my best advice is watchful waiting and coming back in six months to see if it’s changed. If a woman is very nervous, though, it may pay to do surgery.

TNJ: What happens when it is cancer?Dr. Charles: For years we’ve been able to offer women with a lump that’s confined and small—about one centimeter in size—the choice between lumpectomy with radiation, or a mastectomy with chemotherapy. The survival rate’s been shown to be about the same.

TNJ: Why choose one over the other?Dr. Charles: Besides the fact that a lumpectomy requires a smaller incision, the radiation that accompanies it does not—unlike chemotherapy—cause hair loss; that’s a major misconception. And radiation only takes 15 minutes daily. But that’s 15 minutes of treatment every day for six weeks. For women with small breasts, even that one centimeter may be too disfiguring, so a mastectomy with reconstruction is a better option. Other women choose mastectomy because they’re just too worried about a family history and want to be as aggressive as possible, or they’re older and not worried about cosmetics anymore.

TNJ: What else has changed?Dr. Charles: Emphasis on reconstructive procedures is greater. Most insurers now pay for rebuilding the breast, so even women who need a mastectomy don’t feel as disfigured (for lack of a better word) as they might have in an earlier era. In fact, we often take tissue from belly fat or the buttocks, so women say something like, “That’s great. I’ll get a tummy tuck, too!” Just understand that surgery on another area means a longer recovery time and sometimes more pain and discomfort.